Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Sunday, January 30, 2011

Oxymorphone & Hydromorphone in Hospital Emergency Medicine

Bad shit happens. Auto accidents, kidney stones, myocardial infarctions, cluster headaches and broken bones leave the injured in agonizing pain and most likely a trip to a hospital emergency department.

American Physicans tend to be predominantly drawn to the use of morphine in these situations. Morphine, the simple solution, right? Doctors seem to greatly overestimate the power of morphine, and especially the tolerability.


The highly potent and often superior opioids hydromorphone and oxymorphone are very under utilized medicines for this purpose.

In acute management of sudden pain, such as the emergency room setting, 1mg of oxymorphone IV is equivalent to 12.5mg of oxycodone orally; a good dose for a non opioid addict in severe pain such as broken bones or severe injury. Injected directly to the bloodstream however, the oxymorphone will have immediate effect, releiving pain within 10 to 15 seconds and alleviating the suffering of the injured. The effect is amazing to watch first hand; a badly injured person writhing in agony one moment, and within an instant, all tension released, heavy breathing becomes gradual, blood pressure returns to normal, and the patient melts away into a warm, euphoric state of comfort.

Potent morphine derivatives like oxymorphone and hydromorphone give equivalent pain relief to morphine, only in much smaller doses and volumes; not to mention, these newer derivatives cause much fewer side effects in most people. Where morphine leaves a patient often itching and vomiting, Numorphan or Dilaudid are far less prone to these effects. Physicians are somewhat ignorant regarding the superior properties, and better suitability of more modern/refined drugs than morphine. It frustrates me that these Doctors widely still honor morphine as the "King", the gold standard. Giving it to virtually everyone as the first-line, first-choice. In large part due to it's very old age.

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